The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 Tesla: the Beth Israel Deaconess Medical Center (BIDMC) approach.
Management decisions for patients with prostate cancer present a dilemma for both patients and their clinicians because prostate cancers demonstrate a wide range in biologic activity, with the majority of cases not leading to a prostate cancer related death. Furthermore, the current treatment options have significant side effects, such as incontinence, rectal injury and impotence. Key elements for guiding appropriate treatment include: distinction of organ-confined disease from extracapsular extension (ECE); and determination of tumor volume and tumor grade, none of which have been satisfactorily accomplished in today's pre-treatment paradigm. Magnetic resonance imaging (MRI) has the capability to assess prostate tissue, both functionally and morphologically. MRI as a staging tool has not shown enough consistency or sufficient accuracy for widespread adoption in clinical practice; yet, recent technical developments in MRI have yielded improved results. At our institution we have combined the use of new endorectal 3 Tesla MRI technology, T2-weighted, and high spatial resolution dynamic-contrast enhanced (DCE) MRI to non-invasively assess the prostate with higher signal-to-noise ratio and spatial resolution than previously achieved. This approach allows assessment of prostate-tissue morphology and kinetics, thus providing a non-invasive tool for tumor detection and staging and, consequently, directing biopsy and treatment specifically to diseased areas for a pre-treatment evaluation that can assist in the rational selection of patients for appropriate prostate cancer therapy.
Bloch
B Nicolas
BN
Department of Radiology, MRI, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. nbloch@bidmc.harvard.edu
Lenkinski
Robert E
RE
Rofsky
Neil M
NM
D006801:Humans; D007700:Kinetics; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012007:Rectum; D012189:Retrospective Studies; D014463:Ultrasonography